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Old 09-29-2012, 10:19 PM   #1
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Can someone tell me about a hip arthroscopy

Hello, 1st time in the knee and hip section. 6 months ago, on a short brisk walk, it felt like I pulled or even tore a groin muscle. After an MRI my Orthopedic Surgeon told me that nearly half of the labrum in my right hip is completely calcified and is acting like a stone grinding in my hip. I have been through many, many surgeries, but for some reason this one scares me really bad. My hip hurts 6/10 to 8/10 on a constant basis. Is this a tough surgery to get through? My Orthopedic does a newer type procedure. I am not even sure what he does but it doesn't involve any anchors and tiny rope to hold the labrum in place. I have a pre-op with him on Tuesday and my Surgery is Friday. Anyone have an thoughts on hip arthroscopy? Post-op pain? General recovery? Thanks.
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2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

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Old 09-29-2012, 11:05 PM   #2
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Re: Can someone tell me about a hip arthroscopy

This is a less invasive surgery and one that you recover from more quickly...This should postpone your needing a full knee replacement in the near future..I only wish my husband had looked into this before he had his full hip replacement done...Good luck...ILD.....

 
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Old 09-30-2012, 01:17 AM   #3
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Re: Can someone tell me about a hip arthroscopy

Hi there -- I had three hip arthroscopies in less than five years. The surgical recovery varies depending on the amount of work done and the skill of the surgeon. Hip scopes are much more invasive than knee scopes, primarily because of the traction used to distract the hip joint to get the surgical tools inside. (I've had two surgeries requiring post-op hospitalization: corrective surgery on my jaw as a teen and an L4-L5 ALIF last December; my out-patient hip scopes had much more difficult recoveries.)

I made the mistake of having my first surgery with a general orthopedic surgeon rather than a hip specialist. The four hour surgery was a simple labral trim; he took the majority of the surgery forcing my hip joint open and ramming the tools into the joint. I was better off before that surgery than I've been since. However, I did not have constant pain. I had immobilizing 9-10 pain every couple of weeks when my hip would get stuck and would need to have someone come and move my leg for me. Otherwise, I had zero pain.

My second and third surgeries were with a specialist. My second surgery involved reshaping the bone surfaces to resolve femoral acetabular impingement, so I had to spend a long time on crutches. The third surgery was to try to get the labrum to reattach to the bone; a little more than half of it had detached. The surgeon performed microfracture under the cartilage and used plastic anchors around the edge. He wanted me to put weight on it right away, to act as a pressure bandage for the cartilage.

Make sure you are with a doctor who does hip scopes regularly and who specializes in hips. Make sure your doctor has a plan to get into the hip joint if the traction alone is not sufficient. For my second and third surgeries, the doctor cut through the hip capsule, since my joint is tight. Right after my third surgery, I would stand using my crutches and move my leg in small circles. I found that this mobilization, in addition to the slow stationary cycling, really helped to minimize swelling.

I hate to sound all gloom and doom, but I think that folks mistakenly downplay hip scopes. I have never had a knee arthroscopy, so I can't compare them. Hip scopes are almost always done under general anesthesia. I made the mistake of having my first hip scope on a Wednesday and returning to a desk job the following Monday. For my second and third scopes, I took four weeks off work, then started working part-time. I find that having a gradual return allows me to increase my stamina. If your employer allows such a schedule, I highly recommend it.

 
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Old 10-01-2012, 12:01 AM   #4
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Re: Can someone tell me about a hip arthroscopy

Thanks SweetPeainSF! My hip Dr. is a hip specialist who has done hundreds of these surgeries. That said, as you can seem from my signature, I too have had have had serious spine surgeries and the fusions were brutal. My main fear is pain management. I have a great GP who took over my pain management because the only PM specialists in my area had such a high turnover (poor management) that I literally saw a different Dr. every time and each one charged me for a consultation which drove my Insurance crazy and ran up my costs. Plus, they really had me taking way too much medicine (300mg Avinza [24 HR time released morphine] Plus Norco for breakthrough). I told them that we needed to reduce the amount because I was so high all the time, I was loosing my mind and memory. They ramped me down too fast and when I told them that we had gone down to far, the claimed all of this was their idea because I had been "abusing" my meds. I never failed a pill count, drug screen or any of their regulations. It was simply the turn over and the lack of communication between Dr's. They also did a Dr. switch they day of a thoracic Radio Frequency Ablation. It was planned with conscious sedation but the new Dr. didn't believe in any sedation and told me that he had done these on 12 year old girls and THEY were able to handle it. I went along but lasted 30 seconds and told a Nurse that was present that they should unhook me before I started ripping things out. It was the most painful thing I had ever experienced. I told my GP about all of this and he told me he had heard many other complaints about them and he took on my pain management. He has been great but when this hip issue came along he insisted it was coming from my lumbar spine and despite my repeated explanation that it was a torn muscle or hip problem, he still sent me to a spine specialist. A wasted MRI and consult later I found that, while I did have further degeneration in my entire lumbar spine, nothing was indicative of something that would cause the type of pain I was in. The spine specialist sent me to their in house hip specialist and here we are. On a revisit with my GP, I told him in a very nice and professional manner that he should have listened to me. I should have just let it go because he then refused to increase my meds to help with this new, acute pain. He told me to have my hip specialist to handle it. All of it. A Doctor that I am going to see a few times is supposed to handle my chronic pain from thoracic spine problems? Very strange idea. Currently I take methadone and Norco for chronic pain. It was working perfectly prior to this hip problem. My Hip specialist has already told me that all he prescribes is Norco for post op pain. So, if I took his script and the Norco script from my GP, I would be taking 12-14 10mg of Norco per day. That would 3900+ mg of acetaminophen per day, well past recommended amounts. I have calls into my GP for clarification that have gone 5 business days without a call back. This has me scared to death. Seems as if my GP's ego was bruised when I told him that he needs to listen to me. This is a Dr. that I have been seeing for 8 years and we had a great relationship. My pre-op with my Hip specialist got moved up to tomorrow at 9am. Surgery is still Friday. I am going to ask the specialist, or his assistant, to call my GP and work this out. We'll see how that goes. The town I live in is only about 80k people and all the Dr's are very clique. They cover each others neck very well. Boy I hope I can get this worked out. The stress alone is bad enough. The pain is bordering on cruelty. The traction they plan to do really scares me. I am a big guy at 6'5" and 280lbs. My legs, hips and backside are large. My quad muscles and groin muscles and tendons are thick. I would imagine separation would take a lot of torque. Do they completely dislocated the hip or just separate it a bit? Oh, I will be having half my labrum removed and some resurfacing of the femoral head and the acetabelum. I don't have to worry about returning to work. With so many problems with my spine, I am on SSDI. Thanks so much for being frank about this surgery. It really helps to know going in what is going to happen. I really hope its not as bad as the 10 HR lumbar surgery I had. Heck, my cervical fusion was bad enough because of the atlas collar I had to wear for three months when if was 110* where I live. They told me I would be going home the day of this hip surgery. Seems crazy.
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2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

Last edited by Bilbo; 10-01-2012 at 12:10 AM.

 
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Old 10-03-2012, 11:25 PM   #5
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Re: Can someone tell me about a hip arthroscopy

Bilbo, let me know how surgery went.

Sweetpea,
I have a couple questions. You have costo too, how did you do with the costo and being on crutches? Second, I remember you went to see Vail at UCSF, do you know how many scopes he's done? Do you know how many Safran has done? I probably won't be seeing Sampson due to insurance. Is there any other hip specialist in CA you would suggest seeing? I saw Jamali, he has done about 400 scopes.

 
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Old 10-06-2012, 01:44 PM   #6
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Re: Can someone tell me about a hip arthroscopy

Hi everyone -- I've been off-line this week due to a 939 page report that I had one week to summarize, redact and get filed. Not much sleep; tons of stress! I wanted to get back and answer some of Bilbo's questions before his surgery, but I fear I may be late. If he had surgery, I hope it went well!

Dealing with doctors' egos can be really, really tough. My grandfather was a surgeon, and my mom has been able to give me insight in this area. Bilbo, if you otherwise liked your GP, you could go back, hat in hand, and thank your GP for his thoroughness in treating what turned out to be a hip problem. Explain that you have been in a lot of pain, that the delay was frustrating, and that you want to work with him to resolve your health issues and to monitor your overall health. If his ego is too big/bruised to accept and explanation and apology, then time to move on.

As far as the acetaminophen, your pharmacist may be able to help you out. I can't take any, so I have been on tramadol for pain, roxycodone immediately after surgery. If you can't work things out with your GP, can the spine specialist who referred you to your hip guy treat your chronic spine problems/pain?

Ronnald -- My costochondritis wasn't really flared by crutches. I had a protruding cervical disk, which was causing weakness and a much bigger concern w/ my lasy hip surgery. Using a walker is another option. Not sexy, but effective. I used one after my lumbar surgery. They aren't expensive, so if your insurance covers only crutches or a walker, you could pay cash for the other and rotate them.

I didn't ask Vail about how many scopes he had done. I last saw him in 2006 or 07, and my impression was that he was primarily a replacer during that time. He may have migrated into more scopes since then. I don't know of other NorCal specialists. If you really liked Sampson, you might want to call his office and talk about finances/insurance. If it's totally a no-go with him, you could ask for his assessment of other area hip doctors. He knows most of them and -- while most doctors won't say anything negative about each other -- you can gauge how positive he sounds about other doctors.

 
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Old 10-12-2012, 10:46 AM   #7
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Re: Can someone tell me about a hip arthroscopy

Hello folks, just an update about my hip scope. I had it 10/5. We finally caught a huge break in that we happened to know the Anesthesiologist very well. He is good friends of my Wife through her employer. Along with general anesthesia he did a femoral nerve block and we now call him the "Nerve Sniper" because he nailed it without any complication. The 5 day full leg nerve block made the post op pain minimal, thank yo very much! Its now the 12th and I have had only two times where my pain levels got out of control. One of those times my crutches crossed and I fell. No damage to the hip but bruises elsewhere. The other one is related to my GP. To put a fine point on all the previous posts, all I wanted was my Methadone to be written so I could get it filled before my surgery so I wasn't trying to run around on crutches post op. The script would have been filled 6 days early. I never got a call back so I just bit my tongue and prayed all would be OK. Anyway, the following Monday after my Friday surgery, I called all my script into my pharmacy and my Methadone into my Dr's assistant. To my astonishment, the pharmacy called me within an hour to let me know my scripts were filled. Keep in mind that it takes this pharmacy takes at least 4 days. Also, I got a call from some other Assistant in my GP's office letting me know that my Methadone script was ready to go. This was literally less than an hour after I called it in. I was both flabbergasted and angry. They refused to fill it on Friday 10/5 while I was still ambulatory, but had no problems and even super rushed to fill it on Monday 10/8, which was still 4 days early!!! Every reason the cited for not filling it on Friday they violated on Monday. My wife had to work so I had to not take any pain meds that morning because its a 15 mile drive into where I needed to go. I also had to get a testosterone injection. When they took me back into a room to give me my shot, my GP was there doing paperwork. I was using a cane and was in quite a bit of pain. All he could manage was a brief look up and a weak "hey". No, "Hey, how are you felling". Pathetic. Despite the anger because of the mismanagement and that my pain is going through the roof, I kept it somewhat civil and just replied, almost mockingly, "hey".

I find all of this so bizarre. I have some time to consider my options. 1st plan is to get my sutures removed and to get into the pool ASAP. Time to resume what I had started. I had lost 40lbs when this hip ordeal came along. All I was doing was walking and eating right. If I can get down to 240, I should be much better off. I'm 6'5" and 290. I was 310lbs when I started walking. Healing just cant happen fast enough but I am so thankful to the team that did this surgery. I do realize that the verdict isn't all the way in but so far, so good. Thanks all.
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Old 10-23-2012, 11:36 PM   #8
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Re: Can someone tell me about a hip arthroscopy

So glad that your operation went smoothly, even though your GP is still acting ridiculously! I'm amazed that you were able to ambulate with a cane so soon after surgery. Hopefully it's a sign that your hip surgeon had an easy time accessing the interior of the joint. Good tip on the femoral nerve block.

Congrats on your weight loss. I've put on some weight, as well, after having a hip surgery and lumbar fusion in one year. I find that the orthopedic issues are less pronounced when I'm at my goal weight. I'm cheering on your progress and I hope that you find relief. By the way, you might be able to use Tegaderm to cover stitches while in the pool, but of course, ask the doctor.

 
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Old 10-26-2012, 12:07 AM   #9
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Re: Can someone tell me about a hip arthroscopy

Well folks I am sorry to report that, ironically, the day after my post op appointment, my pain levels started to rise and they got to a point where one night I almost went to the ER. Thanks to a very scant knowledge of meditation and breathing techniques I made it through. I thought the pain was a direct result from going to my post op appt since I live 25 mins away and had to drive myself. I waited a couple of days to see if the pain levels would drop with reduced activity. It didn't. I spent my time lying in bed with a cold therapy wrap on, an ice chest with food and drink next to the bed. No matter what I did the pain I had prior to the surgery was back. Inside groin pain. The outside of my hip/leg is just fine. No residual surgical pain at all. Weird.

On Monday the 22nd I finally called and talked to the surgeon's assistant to report what was going on. The surgeon was at a remote office at the time so I couldn't talk to him. I explained to his assistant everything I mentioned above. She said she would call him and get back to me. A few hours later she called and basically told me the Dr thinks its inflamed from too much activity. I sat there scratching my head because I had just got done telling he my only activity was getting up to go to the bathroom and some walking around my house. It was clear that something got lost in translation. In the end we agreed to give it to the end of the week to see if it improves. Here we are, and there has been some improvement but I am still house bound and any walking sets it off and I have to lay down. I cant even sit in my recliner. I don't have a clue as to what is going on. I really like my Surgeon and he came highly recommended but where he fell short is in explaining anything about post op expectations. I blame myself for not being proactive and asking what to expect. I don't know if what I am going through is within the normal spectrum of recovery or if there is a real problem. He told me he removed quite a bit of calcified labrum and did a lot of work on the femoral neck and acetabelum to ward of arthritis setting in. He did say that in 10-15 yrs that I definitely would require a total hip replacement. Something cheery to look forward too.

I am calling tomorrow to report that I have seen about a 10% improvement and that I need more info on what a "normal" recovery looks like. I have found such wildly different reports on this while searching the web. Everything from a week or two to 4-6 MONTHS! This was specifically for hip scopes, not replacements. Of course every case is different but he was in there and he knows what work ad to be done so he should be able to give me something to work off.

If anyone wants to weigh in on their recovery experience, please do. I am so befuddled because my back fusions went better than this and were far more invasive. After a 10 HR 3 level lumbar fusion I was doing way better than this when I was 2 weeks out. Pain levels were stable and I could do far more in terms of activity. Is it the traction that is causing this pain and sometimes a feeling of instability? Is it the debriedment done to the bones that is the problem? Thanks!
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Old 10-27-2012, 12:56 PM   #10
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Re: Can someone tell me about a hip arthroscopy

All three of my hip scopes were far worse recovery-wise than my fusion, but it was one-level rather than three levels, like yours. You might also have increased tolerance to pain medications, which heightens your perception of pain even though medicated.

My most recent hip surgery involved microfracture under the labrum; the surgeon indicated I would likely have improvement around 14 months post-op. Similar patients had improvement between 12 and 18 months, so that's where he got that number. I was on crutches for long trips (more than in the house) for five months post-op, though I was partial weight-bearing.

Ice is your best bet to get the swelling down. You should also be mobilizing the hip without weight. Stationary bike with no resistance, seat really really high, is a good bet. Or, you can stand with your crutches and slide your leg back and forth, make circles. Your doctor make have given you a list of exercises to do in bed; the one I remember is heel slides. Lying on your back, keep your heel on the mattress and raise your knee, sliding your bent leg toward your chest. You don't want the hip to stiffen, which will just be more painful.

Also, any massage you can do in the hip area, away from the surgery portals, may help. Like the side of the hip, where you don't have any pain. I ended up with a band of swollen tissue all around my hip, which was probably a reaction to the traction.

Many people under-estimate a hip scope, because it's arthroscopic rather than open surgery. It's also out-patient, so considered less serious than in-patient operations. Personally, I think it's a mistake for hip arthroscopies to be out-patient. I also had issues with the doctors doing more during the surgery and not finding out until six weeks later, because the PAs usually do the suture removal/wound check at 10 days. Be sure to ask the doctor for a copy of your op report, so that you know what happened during the surgery.

Around six weeks, you should start feeling gradual improvement.

 
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Old 10-27-2012, 04:37 PM   #11
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Re: Can someone tell me about a hip arthroscopy

Thanks SweetPeainSF,
I spoke with my surgeon briefly on the phone and he said with the procedure I had, I should see steady healing (after surgical site ports heal, which they have) for the 1st 6 weeks and then some patients feel they hit a wall. He didn't explain further as it didn't apply. He said that I should have very little problems walking, unassisted, for far longer periods of time than I am experiencing. He was concerned, even given the known problem of pain management, that I am experiencing pain while off my feet in bed, even after sleeping. He wants to see me early next week.

I must say that I have very good range of motion and very little swelling. The problem is, when I get close to the outer range of motion during stretching or sitting in "cross leg position", my hip screams on the groin side after a few minutes. Since I was a kid I had tremendous problems with my hamstrings and groin muscles and ligaments being so so tight. Could never get them loose even after day in, day out stretching regiments that went on for months and months. I have always wondered if they played a roll in my low back problems and now, my hip problems. I played a lot of golf over 25 years and got down to a single digit handicap. Every instructor I saw said I had the tightest hips they had seen for someone who could hit the ball so far. I had to make up for it with a bigger shoulder, spine rotation. But I digress,

In terms of walking, my hip socket feels too loose and sometimes, when walking and having to side step a dog for example, it feels like it wants to slide out. I am doing a short set of exercises given to me by him and they are hard to do because of my back issues and just flat out muscle weakness from having to wait, in bed just about 24/7 for months, because my GP sent me on the wild goose chase insisting it was my lumbar spine "referring pain" to my groin. Ya, still bitter over that but working on it. I do use ice a lot. The hip wrap is now useless as it only directed water to the outside surgical site. I think I mentioned that I am a big guy. My upper legs are tree trunks. I am built like an NFL lineman in every sense except for strength, obviously. Its really hard to get the therapy of ice deep into the hip without nearly subjecting my skin to frostbite. I still do it as a matter of known best practice but I haven't seen my relief from it.

Will know more in a few days. Thanks for your experiences. They line up more with some of the testimonials I have read on the net. I plan to press my doc more as most of my visits have been bang bang. Not this time.
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2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
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